TÍTULO NÚMERO REVISÃO PÁGINA

SHIP SHORE SAFETY CHECKLIST FORM-TECMA-002 01 1 de 13

‘

ISGOTT Checks pre-arrival Ship/Shore Safety Checklist

Date and time:

Port and berth:

Tanker:

Terminal:

Product to be transferred:

Part 1A. Tanker: checks pre-arrival

Item Check Status Remarks

1 Pre-arrival information is exchanged ◻ Yes

(6.5, 21.2)

2 International shore fire connection is ◻ Yes

available (5.5, 19.4.3.1)

3 Transfer hoses are of suitable construction ◻ Yes

(18.2)

4 Terminal information booklet reviewed ◻ Yes

(15.2.2)
5 Pre-berthing information is exchanged ◻ Yes
(21.3, 22.3)

6 Pressure/vacuum valves and/or high ◻ Yes

velocity vents are operational (11.1.8)

7 Fixed and portable oxygen analyzers ◻ Yes

are operational (2.4)

Part 1B. Tanker: checks pre-arrival if using an inert gas

system
Item Check Status Remarks

8 Inert gas system pressure and ◻ Yes

oxygen recorders are operational
(11.1.5.2, 11.1.11)
9 Inert gas system and associated ◻ Yes
equipment are operational (11.1.5.2,
11.1.11)
10 Cargo tank atmospheres’ oxygen content ◻ Yes
is less than 8% (11.1.3)

11 Cargo tank atmospheres are at ◻ Yes

positive pressure (11.1.3)
 TÍTULO NÚMERO REVISÃO PÁGINA

SHIP SHORE SAFETY CHECKLIST FORM-TECMA-002 01 2 de 13

‘

Part 2. Terminal: checks pre-arrival

Item Check Status Remarks

12 Pre-arrival information is exchanged ◻ Yes

(6.5, 21.2)

13 International shore fire connection is ◻ Yes

available (5.5, 19.4.3.1, 19.4.3.5)

14 Transfer equipment is of suitable ◻ Yes

construction (18.1, 18.2)

15 Terminal information booklet transmitted ◻ Yes

to tanker (15.2.2)

16 Pre-berthing information is exchanged ◻ Yes

(21.3, 22.3)

ISGOTT Checks after mooring Ship/Shore Safety Checklist

Part 3. Tanker: checks after mooring

Item Check Status Remarks

17 Fendering is effective (22.4.1) ◻ Yes

18 Mooring arrangement is effective ◻ Yes

(22.2, 22.4.3)

19 Access to and from the tanker is safe (16.4) ◻ Yes

20 Scuppers and savealls are plugged ◻ Yes

(23.7.4, 23.7.5)

21 Cargo system sea connections and ◻ Yes

overboard discharges are secured (23.7.3)

22 Very high frequency and ultra-high ◻ Yes

frequency transceivers are set to low
power mode (4.11.6, 4.13.2.2)

23 External openings in superstructures ◻ Yes

are controlled (23.1)

24 Pumproom ventilation is effective (10.12.2) ◻ Yes

25 Medium frequency/high frequency ◻ Yes

radio antennae are isolated (4.11.4,
4.13.2.1)
26 Accommodation spaces are at positive ◻ Yes
pressure (23.2)

27 Fire control plans are readily ◻ Yes

available (9.11.2.5)
 TÍTULO NÚMERO REVISÃO PÁGINA

SHIP SHORE SAFETY CHECKLIST FORM-TECMA-002 01 3 de 13

‘

Part 4. Terminal: checks after mooring

Item Check Status Remarks

28 Fendering is effective (22.4.1) ◻ Yes

29 Tanker is moored according to the terminal ◻ Yes

mooring plan (22.2, 22.4.3)

30 Access to and from the terminal is safe ◻ Yes

(16.4)
31 Spill containment and sumps are ◻ Yes
secure (18.4.2, 18.4.3, 23.7.4,
23.7.5)
Part 5A. Tanker and terminal: pre-transfer conference

Tanke Termina
Item Check Remarks
r l status
statu
s
32 Tanker is ready to move at agreed ◻ Yes ◻ Yes
notice period (9.11, 21.7.1.1, 22.5.4)

33 Effective tanker and terminal ◻ Yes ◻ Yes

communications are established (21.1.1,
21.1.2)
34 Transfer equipment is in safe condition ◻ Yes ◻ Yes
(isolated, drained and de-pressurized)
(18.4.1)
35 Operation supervision and watchkeeping is ◻ Yes ◻ Yes
adequate (7.9, 23.11)

36 There are sufficient personnel to deal with ◻ Yes ◻ Yes

an emergency (9.11.2.2, 23.11)

37 Smoking restrictions and designated ◻ Yes ◻ Yes

smoking areas are established (4.10,
23.10)
38 Naked light restrictions are established ◻ Yes ◻ Yes
(4.10.1)
39 Control of electrical and electronic devices ◻ Yes ◻ Yes
is agreed (4.11, 4.12)

40 Means of emergency escape from both ◻ Yes ◻ Yes

tanker and terminal are established (20.5)

41 Firefighting equipment is ready for use (5, ◻ Yes ◻ Yes

19.4, 23.8)

42 Oil spill clean-up material is available (20.4) ◻ Yes ◻ Yes

43 Manifolds are properly connected (23.6.1) ◻ Yes ◻ Yes

44 Sampling and gauging protocols are ◻ Yes ◻ Yes

agreed (23.5.3.2, 23.7.7.5)
 TÍTULO NÚMERO REVISÃO PÁGINA

SHIP SHORE SAFETY CHECKLIST FORM-TECMA-002 01 4 de 13

‘
45 Procedures for cargo, bunkers and ◻ Yes ◻ Yes
ballast handling operations are agreed
(21.4, 21.5,
21.6)
46 Cargo transfer management controls ◻ Yes ◻ Yes
are agreed (12.1)

47 Cargo tank cleaning requirements, ◻ Yes ◻ Yes See also parts 7B/7C as applicable
including crude oil washing, are agreed
(12.3, 12.5, 21.4.1)

Part 5A. Tanker and terminal: pre-transfer conference (cont.)

Tanke Termin
Item Check Remarks
r al
statu status
s
48 Cargo tank gas freeing arrangements ◻ Yes ◻ Yes See also part 7C
agreed (12.4)

49 Cargo and bunker slop handling ◻ Yes ◻ Yes See also part 7C
requirements agreed (12.1, 21.2, 21.4)

50 Routine for regular checks on cargo ◻ Yes ◻ Yes

transferred are agreed (23.7.2)

51 Emergency signals and shutdown ◻ Yes ◻ Yes

procedures are agreed (12.1.6.3, 18.5,
21.1.2)
52 Safety data sheets are available (1.4.4, 20.1, ◻ Yes ◻ Yes
21.4)
53 Hazardous properties of the products to ◻ Yes ◻ Yes
be transferred are discussed (1.2, 1.4)

54 Electrical insulation of the ◻ Yes ◻ Yes

tanker/terminal interface is effective
(12.9.5, 17.4, 18.2.14)
55 Tank venting system and closed operation ◻ Yes ◻ Yes
procedures are agreed (11.3.3.1, 21.4, 21.5,
23.3.3)
56 Vapour return line operational parameters ◻ Yes ◻ Yes
are agreed (11.5, 18.3, 23.7.7)

57 Measures to avoid back-filling are ◻ Yes ◻ Yes

agreed (12.1.13.7)

58 Status of unused cargo and bunker ◻ Yes ◻ Yes

connections is satisfactory (23.7.1, 23.7.6)

59 Portable very high frequency and ultra ◻ Yes ◻ Yes

high frequency radios are intrinsically
safe (4.12.4,
21.1.1)
60 Procedures for receiving nitrogen from ◻ Yes ◻ Yes
terminal to cargo tank are agreed
(12.1.14.8)

Part 5B. Tanker and terminal: bulk liquid chemicals. Checks pre-transfer
 TÍTULO NÚMERO REVISÃO PÁGINA

SHIP SHORE SAFETY CHECKLIST FORM-TECMA-002 01 5 de 13

‘
Tanke Termin
Item Check Remarks
r al
statu status
s
61 Inhibition certificate received (if required) ◻ Yes ◻ Yes
from manufacturer

62 Appropriate personal protective ◻ Yes ◻ Yes

equipment identified and available
(4.8.1)
63 Countermeasures against personal contact ◻ Yes ◻ Yes
with cargo are agreed (1.4)

64 Cargo handling rate and relationship with ◻ Yes ◻ Yes

valve closure times and automatic
shutdown systems is agreed (16.8, 21.4,
21.5, 21.6)
65 Cargo system gauge operation and alarm ◻ Yes ◻ Yes
set points are confirmed (12.1.6.6.1)
 TÍTULO NÚMERO REVISÃO PÁGINA

SHIP SHORE SAFETY CHECKLIST FORM-TECMA-002 01 6 de 13

‘

Part 5B. Tanker and terminal: bulk liquid chemicals. Checks pre-transfer
(cont.)
Tanke Termin
Item Check Remarks
r al
statu status
s
66 Adequate portable vapour detection ◻ Yes ◻ Yes
instruments are in use (2.4)

67 Information on firefighting media and ◻ Yes ◻ Yes

procedures is exchanged (5, 19)

68 Transfer hoses confirmed suitable for the ◻ Yes ◻ Yes

product being handled (18.2)

69 Confirm cargo handling is only by a ◻ Yes ◻ Yes

permanent installed pipeline system

70 Procedures are in place to receive nitrogen ◻ Yes ◻ Yes

from the terminal for inerting or purging
(12.1.14.8)

Part 5C. Tanker and terminal: liquefied gas. Checks pre-transfer

Tanke Termin
Item Check Remarks
r al
statu status
s
71 Inhibition certificate received (if required) ◻ Yes ◻ Yes
from manufacturer

72 Water spray system is operational (5.3.1, ◻ Yes ◻ Yes

19.4.3)
73 Appropriate personal protective equipment ◻ Yes ◻ Yes
is identified and available (4.8.1)

74 Remote control valves are operational ◻ Yes ◻ Yes

75 Cargo pumps and compressors are operational ◻ Yes ◻ Yes

76 Maximum working pressures are agreed ◻ Yes ◻ Yes

between tanker and terminal (21.4, 21.5,
21.6)
77 Reliquefaction or boil-off control equipment ◻ Yes ◻ Yes
is operational

78 Gas detection equipment is appropriately set ◻ Yes ◻ Yes

for the cargo (2.4)

79 Cargo system gauge operation and alarm ◻ Yes ◻ Yes

set points are confirmed (12.1.6.6.1)

80 Emergency shutdown systems are tested ◻ Yes ◻ Yes

and operational (18.5)

81 Cargo handling rate and relationship with ◻ Yes ◻ Yes

valve closure times and automatic
shutdown systems is agreed (16.8, 21.4,
21.5, 21.6)
 TÍTULO NÚMERO REVISÃO PÁGINA

SHIP SHORE SAFETY CHECKLIST FORM-TECMA-002 01 7 de 13

‘
82 Maximum/minimum ◻ Yes ◻ Yes
temperatures/pressures of the cargo to be
transferred are agreed (21.4, 21.5, 21.6)

83 Cargo tank relief valve settings are ◻ Yes ◻ Yes

confirmed (12.11, 21.2, 21.4)
 TÍTULO NÚMERO REVISÃO PÁGINA

SHIP SHORE SAFETY CHECKLIST FORM-TECMA-002 01 8 de 13

‘

Part 6. Tanker and terminal: agreements pre-transfer

Part Tanke Termin

Agreement Details
5 r al
item initial initials
s
32 Tanker manoeuvring readiness Notice period (maximum) for full readiness to
manoeuvre:

Period of disablement (if permitted):

33 Security protocols Security level:

Local requirements:

33 Effective tanker/terminal Primary system:

communications
Backup system:

35 Operational supervision and Tanker:

watchkeeping
Terminal:

37 Dedicated smoking areas and Tanker:

38 naked lights restrictions
Terminal:

45 Maximum wind, current and Stop cargo

sea/swell criteria or other
environmental factors transfer:

Disconnect:

Unberth:
45 Limits for cargo, bunkers and Maximum transfer rates:
46 ballast handling
Topping-off rates:

Maximum manifold pressure:

Cargo temperature:

Other limitations:
 TÍTULO NÚMERO REVISÃO PÁGINA

SHIP SHORE SAFETY CHECKLIST FORM-TECMA-002 01 9 de 13

‘

Part 6. Tanker and terminal: agreements pre-transfer

(cont.)
Part Tanke Termin
Agreement Details
5 r al
item initial initials
s
45 Pressure surge control Minimum number of ship’s cargo tanks open:
46
Ship tank switching protocols:

Minimum number of shore tanks open:

Shore tank switching protocols:

Full load rate:

Topping-off rate:

Closing time of automatic valves:

46 Cargo transfer management Action notice periods:

procedures
Transfer stop protocols:

50 Routine for regular checks on Routine transferred quantity checks:

cargo transferred are agreed

51 Emergency signals Tanker:

Terminal:

55 Tank venting system Procedure:

55 Closed operations Requirements:

56 Vapour return line Operational parameters:

Maximum flow rate:

60 Nitrogen supply from terminal Procedures to

receive: Maximum

pressure:

Flow rate:
 TÍTULO NÚMERO REVISÃO PÁGINA

SHIP SHORE SAFETY CHECKLIST FORM-TECMA-002 01 10 de 13

‘

Part 6. Tanker and terminal: agreements pre-transfer

(cont.)
Part
Tanke Termin
5 Agreement Details
r al
item
initial initials
ref
s
83 For gas tanker only: Tank 1:
cargo tank relief valve settings Tank 2:
Tank 3:
Tank 4:
Tank 5:
Tank 6:
Tank 7:
Tank 8:
Tank 9:
Tank 10:

XX Exceptions and additions Special issues that both parties should be aware of:

Part 7A. General tanker: checks pre-transfer

Item Check Status Remarks

84 Portable drip trays are correctly ◻ Yes

positioned and empty (23.7.5)

85 Individual cargo tank inert gas supply ◻ Yes

valves are secured for cargo plan
(12.1.13.4)
86 Inert gas system delivering inert gas ◻ Yes
with oxygen content not more than
5% (11.1.3)
87 Cargo tank high level alarms are ◻ Yes
operational (12.1.6.6.1)

88 All cargo, ballast and bunker tanks ◻ Yes

openings are secured (23.3)

Part 7B. Tanker: checks pre-transfer if crude oil washing is

planned
Item Check Status Remarks

89 The completed pre-arrival crude oil ◻ Yes

washing checklist, as contained in the
approved crude oil washing manual, is
copied to terminal (12.5.2, 21.2.3)
 TÍTULO NÚMERO REVISÃO PÁGINA

SHIP SHORE SAFETY CHECKLIST FORM-TECMA-002 01 11 de 13

‘
90 Crude oil washing checklists for use before, ◻ Yes
during and after crude oil washing are in
place ready to complete, as contained in
the approved crude oil washing manual
(12.5.2, 21.6)
 TÍTULO NÚMERO REVISÃO PÁGINA

SHIP SHORE SAFETY CHECKLIST FORM-TECMA-002 01 12 de 13

‘

ISGOTT Checks after pre-transfer conference Ship/Shore

Safety Checklist
For tankers that will perform tank cleaning alongside and/or gas freeing alongside

Part 7C. Tanker: checks prior to tank cleaning and/or gas

freeing
Item Check Status Remarks

91 Permission for tank cleaning operations ◻ Yes

is confirmed (21.2.3, 21.4, 25.4.3)

92 Permission for gas freeing operations ◻ Yes

is confirmed (12.4.3)

93 Tank cleaning procedures are agreed ◻ Yes

(12.3.2, 21.4, 21.6)

94 If cargo tank entry is required, ◻ Yes

procedures for entry have been agreed
with the terminal (10.5)

95 Slop reception facilities and requirements ◻ Yes

are confirmed (12.1, 21.2, 21.4)
 TÍTULO NÚMERO REVISÃO PÁGINA

SHIP SHORE SAFETY CHECKLIST FORM-TECMA-002 01 13 de 13

‘
Declaration
We the undersigned have checked the items in the applicable parts 1 to 7 as marked and signed below:

Tanker Terminal
Part 1A. Tanker: checks pre-arrival
◻ ◻
Part 1B. Tanker: checks pre-arrival if using an inert gas system
◻ ◻
Part 2. Terminal: checks pre-arrival
◻ ◻
Part 3. Tanker: checks after mooring
◻ ◻
Part 4. Terminal: checks after mooring
◻ ◻
Part 5A. Tanker and terminal: pre-transfer conference
◻ ◻
Part 5B. Tanker and terminal: bulk liquid chemicals. Checks pre-transfer
◻ ◻
Part 5C. Tanker and terminal: liquefied gas. Checks pre-transfer
◻ ◻
Part 6. Tanker and terminal: agreements pre-transfer
◻ ◻
Part 7A. General tanker: checks pre-transfer
◻ ◻
Part 7B. Tanker: checks pre-transfer if crude oil washing is planned
◻ ◻
Part 7C. Tanker: checks prior to tank cleaning and/or gas freeing
◻ ◻

In accordance with the guidance in chapter 25 of ISGOTT, we have satisfied ourselves that the entries
we have made are correct to the best of our knowledge and that the tanker and terminal are in
agreement to undertake the transfer operation.
We have also agreed to carry out the repetitive checks noted in parts 8 and 9 of the ISGOTT SSSCL,
which should occur at intervals of not more than hours for the tanker and
not more than hours for the terminal.
If, to our knowledge, the status of any item changes, we will immediately inform the other party.

Tanker Terminal

Name Name

Rank Position

Signature Signature
 TÍTULO NÚMERO REVISÃO PÁGINA

SHIP SHORE SAFETY CHECKLIST FORM-TECMA-002 01 14 de 13

‘
Date Date

Time Time

ISGOTT Checks during transfer Ship/Shore Safety Checklist

Repetitive checks

Part 8. Tanker: repetitive checks during and after transfer

Date Date Date Date Date Date Date

Ite
Check Remarks
m
ref

Interval time: hrs

8 Inert gas system ◻ Yes ◻ Yes ◻ Yes ◻ Yes ◻ Yes ◻ Ye ◻ Ye

pressure and oxygen s s
recording operational

9 Inert gas system and ◻ Yes ◻ Yes ◻ Yes ◻ Yes ◻ Yes ◻ Ye ◻ Ye

all associated s s
equipment are
operational
11 Cargo tank ◻ Yes ◻ Yes ◻ Yes ◻ Yes ◻ Yes ◻ Ye ◻ Ye
atmospheres are at s s
positive pressure

18 Mooring ◻ Yes ◻ Yes ◻ Yes ◻ Yes ◻ Yes ◻ Ye ◻ Ye

arrangement is s s
effective
19 Access to and from ◻ Yes ◻ Yes ◻ Yes ◻ Yes ◻ Yes ◻ Ye ◻ Ye
the tanker is safe s s
20 Scuppers and ◻ Yes ◻ Yes ◻ Yes ◻ Yes ◻ Yes ◻ Ye ◻ Ye
savealls are plugged s s
23 External openings ◻ Yes ◻ Yes ◻ Yes ◻ Yes ◻ Yes ◻ Ye ◻ Ye
in superstructures s s
are controlled

24 Pumproom ◻ Yes ◻ Yes ◻ Yes ◻ Yes ◻ Yes ◻ Ye ◻ Ye

ventilation is s s
effective
28 Tanker is ready to ◻ Yes ◻ Yes ◻ Yes ◻ Yes ◻ Yes ◻ Ye ◻ Ye
move at agreed s s
notice period
29 Fendering is effective ◻ Yes ◻ Yes ◻ Yes ◻ Yes ◻ Yes ◻ Ye ◻ Ye
s s
33 Communications are ◻ Yes ◻ Yes ◻ Yes ◻ Yes ◻ Yes ◻ Ye ◻ Ye
effective s s
 TÍTULO NÚMERO REVISÃO PÁGINA

SHIP SHORE SAFETY CHECKLIST FORM-TECMA-002 01 15 de 13

‘
35 Supervision ◻ Yes ◻ Yes ◻ Yes ◻ Yes ◻ Yes ◻ Ye ◻ Ye
and s s
watchkeeping
is adequate
36 Sufficient personnel ◻ Yes ◻ Yes ◻ Yes ◻ Yes ◻ Yes ◻ Ye ◻ Ye
are available to deal s s
with an emergency

37 Smoking ◻ Yes ◻ Yes ◻ Yes ◻ Yes ◻ Yes ◻ Ye ◻ Ye

restrictions and s s
designated
smoking areas are
complied with
38 Naked light ◻ Yes ◻ Yes ◻ Yes ◻ Yes ◻ Yes ◻ Ye ◻ Ye
restrictions are s s
complied with

Part 8. Tanker: repetitive checks during and after transfer

(cont.)
39 Control of electrical ◻ Yes ◻ Yes ◻ Yes ◻ Yes ◻ Yes ◻ Yes
devices and
equipment in
hazardous zones is
complied with
40 Emergency ◻ Yes ◻ Yes ◻ Yes ◻ Yes ◻ Yes ◻ Yes
41 response
preparedness is
42
satisfactory
51
54 Electrical insulation ◻ Yes ◻ Yes ◻ Yes ◻ Yes ◻ Yes ◻ Yes
of the
tanker/terminal
interface is
effective
55 Tank venting system ◻ Yes ◻ Yes ◻ Yes ◻ Yes ◻ Yes ◻ Yes
and closed
operation
procedures are as
agreed
85 Individual cargo ◻ Yes ◻ Yes ◻ Yes ◻ Yes ◻ Yes ◻ Yes
tank inert gas
valves
settings are as agreed
86 Inert gas delivery ◻ Yes ◻ Yes ◻ Yes ◻ Yes ◻ Yes ◻ Yes
maintained at not
more than 5%
oxygen
87 Cargo tank high level ◻ Yes ◻ Yes ◻ Yes ◻ Yes ◻ Yes ◻ Yes
alarms are
operational
Initials
 TÍTULO NÚMERO REVISÃO PÁGINA

SHIP SHORE SAFETY CHECKLIST FORM-TECMA-002 01 16 de 13

‘

Part 9. Terminal: repetitive checks during and after transfer

Date Date Date Date Date Date Date

Ite
Check Remarks
m
ref

Interval time: hrs

18 Mooring ◻ Yes ◻ Yes ◻ Yes ◻ Yes ◻ Yes ◻ Ye ◻ Ye

arrangement is s s
effective
19 Access to and from ◻ Yes ◻ Yes ◻ Yes ◻ Yes ◻ Yes ◻ Ye ◻ Ye
the terminal is safe s s
29 Fendering is effective ◻ Yes ◻ Yes ◻ Yes ◻ Yes ◻ Yes ◻ Ye ◻ Ye
s s
32 Spill containment and ◻ Yes ◻ Yes ◻ Yes ◻ Yes ◻ Yes ◻ Ye ◻ Ye
sumps are secure s s
33 Communications are ◻ Yes ◻ Yes ◻ Yes ◻ Yes ◻ Yes ◻ Ye ◻ Ye
effective s s
35 Supervision ◻ Yes ◻ Yes ◻ Yes ◻ Yes ◻ Yes ◻ Ye ◻ Ye
and s s
watchkeeping
is adequate
36 Sufficient personnel ◻ Yes ◻ Yes ◻ Yes ◻ Yes ◻ Yes ◻ Ye ◻ Ye
are available to deal s s
with an emergency

37 Smoking ◻ Yes ◻ Yes ◻ Yes ◻ Yes ◻ Yes ◻ Ye ◻ Ye

restrictions and s s
designated
smoking areas are
complied with
38 Naked light ◻ Yes ◻ Yes ◻ Yes ◻ Yes ◻ Yes ◻ Ye ◻ Ye
restrictions are s s
complied with
39 Control of electrical ◻ Yes ◻ Yes ◻ Yes ◻ Yes ◻ Yes ◻ Ye ◻ Ye
devices and s s
equipment in
hazardous zones is
complied with
40 Emergency ◻ Yes ◻ Yes ◻ Yes ◻ Yes ◻ Yes ◻ Ye ◻ Ye
41 response s s
preparedness is
47
satisfactory
51
54 Electrical insulation ◻ Yes ◻ Yes ◻ Yes ◻ Yes ◻ Yes ◻ Ye ◻ Ye
of the s s
tanker/terminal
interface is
effective
 TÍTULO NÚMERO REVISÃO PÁGINA

SHIP SHORE SAFETY CHECKLIST FORM-TECMA-002 01 17 de 13

‘
55 Tank venting system ◻ Yes ◻ Yes ◻ Yes ◻ Yes ◻ Yes ◻ Ye ◻ Ye
and closed s s
operation
procedures are as
agreed
Initials